Debbie Wall

Changes in Patterns of Teacher Interaction in Primary Classrooms: 1976‐96

For the past two decades there has been persistent controversy regarding the effectiveness of the different teaching methods used in the English primary classroom. One of the earliest studies of the primary classroom, the ORACLE study, described the typical behaviours of teachers and pupils. Since that time there have been various interventions designed ‘to change the way that primary teachers teach’. The research reported here evaluates the success of these interventions by replicating the work of 20 years ago by using the same observation methods in some of the same schools.

Team resource management: a programme for troubled teams

The necessity for effective multidisciplinary team working within increasingly complex health and social care environments has been emphasised in The NHS Plan. Good teamwork makes a critical contribution to effectiveness and innovation in health‐care delivery and it is through such teams that the agenda of quality improvement through clinical governance can be delivered at local level. The NHS Clinical Governance Support Team’s Team Resource Management Programme supports individuals who work directly with poorly performing NHS teams. A case study example illustrates how a team coach has used her experiences on the Programme to facilitate effective change in a “troubled” team in her health‐care organisation.

Being patient-centred: creating health care for our grandchildren

Purpose – To provide an overview of the learning from four practical programmes that explore different aspects of patient participation in healthcare provision.Design/methodology/approach – To describe the origin and rationale for each project or programme, and to summarise the learning from it.Findings – At a variety of levels, involving patients in the design of care services can provide new insights, and leads to more patient‐focused and locally appropriate solutions. Engaging patients appropriately is not a trivial exercise, and those that are engaged need appropriate support, but the resulting solution is often more widely applicable than is first anticipated and can be cost‐neutral.Originality/value – The active participation of patients in the design and provision of care is a widely voiced public and professional aspiration, but is genuinely realised only rarely. The paper describes the principles, benefits and learning common to four practical expressions of that aspiration.

Learning by doing: training general practitioners to be appraisers

Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.

People will support what they help to create: clinical governance large group work

The NHS Clinical Governance Support Team (CGST) has completed a pilot “protected‐time programme”, supported by a small team of national facilitators and delivered locally in 19 NHS pilot sites across England. The programme worked on the premise that health professionals can successfully lead service developments when given time and space to do so. The paper describes the methodology behind this initiative, how local events were organised to “get the whole system into the room” and what was learned by applying tried and tested methodologies such as accelerated service improvement. Some of the changes being implemented in participating NHS Trusts are presented in brief, along with a more detailed case study of work undertaken at Royal Cornwall Hospitals Trust. Having completed the pilot programme, the team is supporting other CGST activities and applying the learning from working with large groups to improve locally delivered care in NHS organisations.

Supporting clinical governance in primary care

Purpose – To report on the clinical governance work of the NHS Clinical Governance Support Teams, Primary Care Team.Design/methodology/approach – The review describes the formation of the NHS Clinical Governance Support Teams Primary Care Team and the development of a range of national clinical governance activities, drawing on a case study example.Findings – The Team have been developing appraisal, and revalidation for general practitioners across the UK, supporting front‐line staff in primary care to improve patient experience by embedding principles of clinical governance into day‐to‐day practice, and are providing an online education and training programme to develop primary care managers. It has established links, and worked collaboratively with a range of partners in its activities.Originality/value – The article provides a summary of the activities of the Primary Care Team and its activities to date. An example of supporting clinical governance in primary care is given in a case study of facilita...

Sharing good practice: knowledge in action

Purpose – The purpose of this article is to describe the development of the NHS Clinical Governance Support Teams (CGST) information products, with a focus on good practice “eurekas” and an integrated management system for storing knowledge and learning; an intranet‐based “action points” system.Design/methodology/approach – The process behind development of a set of products and a system to capture and share good practice in health care.Findings – To ensure that good practice in clinical governance was being disseminated effectively, and to celebrate success, the CGST developed “eurekas” as short, structured accounts of local improvements to health care. To enhance the number of “raw” eurekas turned into finished, online products, the process of production was streamlined through an online “action points” system. This is an effective knowledge management tool for storing, retrieving and monitoring the development of information into a range of products for sharing across the NHS (e.g. stories, case studi...

The Essence of Care in clinical governance

Purpose – To review progress of the Essence of Care Programme of Clinical Governance. To describe its development and highlight its achievements.Design/methodology/approach – The background to the programme is outlined and the methods adopted by the Clinical Governance Support Team (CGST) and NHS personnel involved are described.Findings – At the heart of commitment to improve quality of health care lies Essence of Care to which the fundamental needs and comfort of patients are paramount. This provides a benchmarking tool for national standards of practice across health and social care which is applicable across medical specialties and relevant to all health professionals involved in caring for patients. Fundamental aspects of care were identified based on concerns of patients and professionals; these include communication, personal hygiene, food and nutrition. Standards are agreed between patients, carers, user groups, health care professionals, professional bodies and NHS departments. Systems for feedba...

Clinical Governance Support Team: patients as a virtue

A core objective of the NHS Clinical Governance Support Team (CGST) is to enable the NHS to improve the experience of patients and staff. In its programmes the CGST encourages delegates to work with patients and carers to improve local health services, but does the CGST practice what it preaches in its own activities? This paper examines how patients and carers are involved in the work of the CGST, specifically as patient consultants in the CGST’s Performance Development Team (PDT). In their role as PDT members, patient consultants provide guidance to the PDT and the trusts with which they engage, focussing their activity and their thinking around improvements in the patient’s experience. They are also working with the wider CGST and are involved in mentoring the acting head of the team.

Developing large group working in clinical governance

Purpose – To report on how service changes can be accelerated by working with large groups that represent all parts of a complete healthcare service or care pathway, during specific events, and using well‐defined facilitation techniques. Design/methodology/approach – Case examples are cited from the Clinical Governance Support Teams “protected time” programme and subsequent work, and specific quotes and examples from large group events are used to describe the potential impact of the approach. Findings – Established group facilitation techniques can be adapted for use in the context of a large group representative of a whole clinical system or pathway, to accelerate service improvement. Originality/value – The paper reports on the practical findings from Clinical Governance Support Team group facilitators working on large group events from a number of UK NHS Trusts.